Individual provider Active NPI

Omeir Tariq Ansari, DDS

  • Dentist
  • Lake Mary, FL
National Provider Identifier
1891337366
Registry record updated Oct 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
24485 Issued in FL
Practice address
3779 Lake Emma Rd
Lake Mary, FL 32746-6156
Phone
(407) 547-1359
NPI assigned
Oct 16, 2019
Last updated
Oct 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 24485 FL Primary

Addresses

Primary practice location

3779 Lake Emma Rd
Lake Mary, FL 32746-6156

Mailing address

5305 Hawk Dr
Kissimmee, FL 34746
Phone (407) 749-9656

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200122000933 FL Order and Referring Only - DentistPractitioner - Dentist 3577998574

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
24485FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Mary Modern Dentistry, PA Dentist PastSince Oct 20, 2019 Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1891337366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5305 HAWK DR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34746",
            "telephone_number": "407-749-9656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3779 LAKE EMMA RD",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327466156",
            "telephone_number": "407-547-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANSARI",
        "first_name": "OMEIR",
        "middle_name": "TARIQ",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-16",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "24485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.